Quality Improvement Program

This section includes medical and technical terms. If you need help understanding this section, please call Member Services at the phone number listed at the bottom of the page.

Purpose

Your care means a lot to us. The TrueCare Quality Management and Improvement program aims to:

  • Coordinate care.
  • Promote quality of care and services.
  • Promote satisfaction with the services you get.
  • Improve the quality and safety of care and services for TrueCare members.

The program covers both health and non-health services. The program is reviewed at least once a year and updated as needed.

Goals and Objectives

We work every day to be a top performing national health plan. Performance goals are determined and aligned with national benchmarks where available.

The goals and objectives of the program include:

  • Improve our members’ health outcomes.
  • Improve member and provider experience.
  • Ensure access to care and services.
  • Promote preventive care and services.
  • Meet the cultural needs of the members we serve.
  • Address health literacy through educational programs.
  • Continually evaluate all care and services members receive and work on improving completion of services and care needed.
  • Obtain and maintain National Committee for Quality Assurance (NCQA) accreditation for health plans and health equity.
  • Maintain a meaningful population health management program.
  • Maintain a robust Early and Periodic Screening, Diagnostic and Treatment program.

Scope

The TrueCare Quality Management and Improvement program governs quality assessment and improvement activities. The scope includes:

  • Meeting the quality requirements of the Centers for Medicare and Medicaid Services (CMS).
  • Meeting the requirements of the TrueCare contract with the Division of Medicaid.
  • Establishing safe clinical practices throughout the network of providers.
  • Providing quality oversight of all clinical services.
  • Compliance with NCQA accreditation standards.
  • Healthcare Effectiveness Data and Information Set (HEDIS) compliance audit and performance measurement.
  • Monitoring and evaluation of member and provider satisfaction.
  • Managing all quality of care and quality of service complaints.
  • Developing organizational competency of the Institute of Healthcare Improvement’s Model for Improvement.
  • Ensuring that TrueCare is effectively serving members with culturally and linguistically diverse needs.
  • Ensuring that TrueCare is effectively serving members with complex health needs.
  • Assessing the characteristics and needs of the member population.
  • Assessing the geographic availability and accessibility of primary and specialty care providers

The TrueCare Quality Management and Improvement program is overseen by the Chief Medical Officer, and implementation is facilitated by the Vice President, Quality Improvement and Performance Outcomes.

Quality Metrics

TrueCare continually assesses and analyzes the quality of care and services offered to our members. This is accomplished by using objective and systematic monitoring and evaluation to implement programs to improve outcomes.

We use HEDIS to measure the quality of care delivered to members. HEDIS is one of the most widely used means of health care measurement in the United States. HEDIS is developed and maintained by the NCQA. HEDIS is used by America’s health plans to measure important dimensions of care and service and allows for comparisons across health plans in meeting state and federal performance measures and national HEDIS benchmarks. HEDIS measures are based on evidence-based care and address the most pressing areas of care. Potential areas of quality measures include:

  • Wellness and prevention
  • Preventive screenings (breast cancer, cervical cancer, chlamydia)
  • Well-child care
  • Chronic disease management
  • Comprehensive diabetes care
  • Controlling high blood pressure
  • Behavioral health

We also use the annual member survey, Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, to capture member perspectives on health care quality. CAHPS is a program overseen by the United States Department of Health and Human Services ―Agency for Healthcare Research and Quality (AHRQ). Potential CAHPS measures include:

  • Customer service
  • Getting care quickly
  • Getting needed care
  • How well doctors communicate
  • Ratings of all health care, health plan, personal doctor, specialist

Preventive Guidelines and Clinical Practice Guidelines

TrueCare approves and adopts nationally accepted standards and guidelines to help inform and guide the clinical care provided to TrueCare members. Guidelines are reviewed and approved by the Division yearly. Guidelines are also reviewed and approved by the TrueCare Provider Advisory Committee yearly or more often as appropriate and updated as necessary. The guidelines are then presented to the TrueCare Enterprise Provider Advisory Committee. The use of these guidelines allows us to measure the impact of the guidelines on outcomes of care. Topics for guidelines are identified through analysis of our members. Guidelines may include, but are not limited to:

  • Preventive health
  • Behavioral health (e.g., depression, Attention Deficit Hyperactivity Disorder, substance use disorder)
  • Chronic condition management (e.g., hypertension, diabetes, cardiovascular disease, cerebrovascular disease and chronic obstructive pulmonary disease)
  • Population health (e.g., obesity, tobacco cessation)

Information about clinical practice guidelines and health information are made available to TrueCare members via this website or upon request. Preventive Guidelines and Health Links are available to members and providers via the website or hard copy.

Your health is important. Here are some ways that you can maintain or improve your health:

  • Establish a relationship with a health care provider.
  • Make sure you and your family have regular checkups with your health care provider.

Make sure if you have a chronic condition (such as asthma or diabetes) that you see your doctor regularly. You also need to follow the treatment that your doctor has given you. Make sure that you take the medications that your doctor has asked you to take.

Remember the 24-Hour Nurse Advice Line is here to help you. You can call the number on your member ID card 24/7/365. You can also access it through your TrueCare MyLife account at MyLife.MSTrueCare.com (Coming Soon).

If you would like more information on TrueCare Quality Improvement, please call Member Services at 1-833-230-2050 (TDD/TTY: 711), Monday through Friday, from 7 a.m. to 8 p.m. Central Time.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Member Services: 1-833-230-2050 (TDD/TTY: 711), Monday through Friday, 7 a.m. to 8 p.m. Central Time (CT).